TX HHS Form H1854. Affidavit for Unauthorized Use of Electronic Benefit Transfer (EBT) Benefits

The TX HHS Form H1854, Affidavit for Unauthorized Use of Electronic Benefit Transfer (EBT) Benefits, is a document used to report and claim unauthorized use of Supplemental Nutrition Assistance Program (SNAP) benefits. This form helps households identify and address instances where their SNAP benefits have been used without authorization.

The form provides instructions on how to access the Lone Star Card transaction history through the YourTexasBenefits.com website or mobile app, allowing users to view account balances, transaction histories, and reset PINs. Households can also contact the Lone Star Help Desk for assistance in accessing their transaction history. The form highlights the importance of reporting unauthorized use within 30 calendar days to ensure replacement benefits are issued.

This affidavit is used when a household discovers that their SNAP benefits have been used without authorization. To complete the form, households must check the box and provide details about the unauthorized transactions, including dates, amounts, retailers, and addresses. If more than five transactions are involved, additional information can be submitted on a separate sheet of paper.